In a nation where most services are overpriced, it’s often assumed health care-related services would be as well. However, I have personally witnessed a 1,000 dollar dental procedure which was conducted for only twenty dollars.
The patient presented with a completely decayed tooth which they had been living with for the past 5 years. He was not aware of any Medicaid-coverage dental clinics in his area, so when he finally found one, he was ecstatic. The practicing dentist informed him that they could remove the decayed tooth and replace it with a ceramic implant tooth for a severely reduced cost from what was typically offered for the same procedure. He immediately and enthusiastically agreed. Once the implant had been placed, the man began to grow emotional. He expressed that he never thought he would get the opportunity to like the way his smile looked, but now he finally could. He was free of the decayed tooth and would be able to eat, talk, and present himself better. Medicaid programs are providing access to quality oral health care in North Carolina and in states across the country. A conjunction of smart laws and policy changes could help expand these programs to other communities in need of affordable, high-quality oral care.
The Office of Disease Prevention and Health Promotion recently released an updated oral health summary report entitled: Oral Health: The Role of Law and Policy in Increasing the Use of Oral Health Services. The report assesses laws, policies, and “bright spots” designed to remove barriers to oral health care, improve community policy knowledge, and improve the financing of affordable oral health initiatives.
However, a mix of barriers and misinformation keeps many eligible people from accessing Medicaid services, including oral care.
Medicaid is a major factor in children’s oral health in the United States. Medicaid programs in every state are required to provide access to oral health care for children and young adults up to age 21. Medicaid provides access to care for over 86 million people and many of its programs are designed to meet the unique needs of low-income people. However, a mix of barriers and misinformation keeps many eligible people from accessing Medicaid services, including oral care. Programs such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) offer high-quality access to oral health care for youth and children in low-income areas, but are not widely known.
Even for families with incomes that exceed the level covered by Medicaid, programs like the Children’s Health Insurance Program (CHIP) can act as a source of insurance for children up to the age of 19. CHIP covers restorative procedures, preventative procedures, and emergency dental services.
For communities who are more likely to develop dental issues than others, such as American Indian and Alaskan Native children, programs such as the Indian Health Service (IHS) offer comprehensive coverage for oral health care.
As for adults, by 2017, under the Affordable Care Act (ACA), roughly 10 million more adults were extended coverage under the ACA’s Medicaid expansion. Additionally, 35 state Medicaid programs offer some form of non-emergency Medicaid coverage for adults related to oral care, and 46 offer at least emergency-only oral care services.
Since accessibility barriers such as transportation and cultural competency still exist for those who fall under Medicaid coverage, Medicaid has developed pathways for improved access. Medicaid regulations require all states to address coverage of transportation services in their Medicaid plans. Guidelines such as the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (CLAS Standards) offer standards for Medicaid providers to help them deliver services which are linguistically and culturally appropriate. Barriers may also exist at the state level, since states provide the licensing to oral health providers and regulate the scope of services for providers. States should push for both traditional and nontraditional providers to be able to provide oral health services as a way to diminish barriers to care. Nontraditional providers are those which provide oral care services outside of an official dental clinic in locations such as schools, community centers, and pharmacies. These nontraditional providers can also be non-dentists, such as dental hygienists and dental therapists. This usually takes the form of preventative screenings, and when performed on children, they can limit the number of dental issues which occur later in life. Removal of the traditional-only provider barrier comes in the form of expanding oral care eligibility at the state and federal level.
After shadowing a dental practice which works almost exclusively with patients on Medicaid, I have been exposed to the attainable possibilities that lie ahead for affordable and accessible oral care. No one should be denied proper dental treatment due to means, language, access, race, or any other identifying attribute. Overall, I believe there is much work still to be done, but there are also many resources available through Medicaid and related programs which are helping to break down barriers and improve oral health care for all.
All information obtained from:
https://www.healthypeople.gov/2020/law-and-health-policy/topic/oral-health
https://www.dentaquest.com/oral-health-resources/the-future-of-oral-health/expanded-access/
About the co-author: Jordyn Williams is a senior Neuroscience major at the University of North Carolina at Chapel Hill (UNC), and is a summer communications intern for NHeLP. She desires to increase access to oral health care in her future profession of dentistry, and has shadowed at Medicaid-coverage dental clinics in North Carolina. Previously, she has volunteered for several free dental clinics offered by her university, and is the current Vice President of UNC’s Undergraduate Student National Dental Association. Her goal is to practice dentistry in rural North Carolina where there is diminished availability of high-quality dental care.
